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Summary Acute lymphoblastic leukaemia (ALL) remains a leading cause of non‐traumatic death in children, and the majority of adults diagnosed will succumb to the disease. Recent advances in molecular biology and bioinformatics hav...
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Summary Acute lymphoblastic leukaemia (ALL) remains a leading cause of non‐traumatic death in children, and the majority of adults diagnosed will succumb to the disease. Recent advances in molecular biology and bioinformatics have enabled more detailed genomic analysis and a better understanding of the molecular biology of ALL. A number of recurrent genomic drivers have recently been described, which not only aid in diagnosis and prognostication, but also may offer opportunities for specific therapeutic targeting. The present review summarises B‐ALL genomic pathology at diagnosis, including lesions detectable using traditional cytogenetic methods as well as those detected only through advanced molecular techniques.
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Although the prognosis for children and young adults with acute lymphoblastic leukaemia (ALL) is excellent after modern intensive treatment, there are several small subgroups who have a high risk of relapse with conventional chemo...
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Although the prognosis for children and young adults with acute lymphoblastic leukaemia (ALL) is excellent after modern intensive treatment, there are several small subgroups who have a high risk of relapse with conventional chemotherapy and are candidates for allogeneic haemopoietic stem cell transplant (allo-HSCT) in first complete remission. One such group is Philadelphia positive (Ph+ve) ALL, which has a poor prognosis in both children and adults. It forms <5% of ALL cases in children but the frequency increases with age to 20-30% in adults. Although conventional chemotherapy can induce remission in >90% of cases, the risk of relapse is exceptionally high if the remission is not consolidated by an allo-HSCT (Arico et al, 2000). Therefore, first complete remission (CR1) allo-HSCT is currently recommended as definitive treatment for all children with Ph+ ALL by the major childhood ALL study groups.
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Acute lymphoblastic leukaemia (ALL) is one of the most common forms of cancer seen in children, accounting for one‐fourth of all childhood cancers. These children typically present with decreased
Acute lymphoblastic leukaemia (ALL) is one of the most common forms of cancer seen in children, accounting for one‐fourth of all childhood cancers. These children typically present with decreased functional mobility, weakened lower extremity muscle strength and reduced exercise endurance and interests because of disease progressions and chemotherapy treatments. The purpose of this case report was to examine the effectiveness of incorporating a play‐based physical therapy (PT) intervention programme to improve functional mobility for an inpatient with relapsed ALL undergoing chemotherapy.
The patient was a 3‐year‐old male admitted to the hospital for relapsed ALL. He was diagnosed approximately 1?year earlier for which he had undergone chemotherapy and was later considered in remission at that time. When the patient relapsed, he underwent another round of chemotherapy and was waiting for a bone marrow transplant during his treatment during the course of this case report. For PT intervention, therapeutic exercises were incorporated into play to strengthen his lower extremity strength and muscle endurance. Functional activities were also incorporated into play to improve his aerobic capacity and overall quality of life. Multi‐attribute health status classification system (HUI3) utility scores, 6‐minute walk test distance (6MWT), lower extremity (LE) strength, transfer and tolerated treatment time were assessed to identify the effect of a PT intervention.
Despite experiencing fatigue, the patient completed most of the treatments incorporated into play. After 5?weeks of PT intervention, the participant improved on HUI3 (pre: 0.72 and post: 0.92), 6MWT (pre: 156?ft and post: 489?ft), LE strength (squat), transfer (sit to stand) and tolerated treatment time (pre: 16?minutes and post: 44?minutes).
This case report suggests that incorporating a play‐based PT intervention programme could be physically tolerable and functionally beneficial for a young child with relapsed ALL undergoing inpatient chemotherapy. Copyright ? 2016 John Wiley & Sons, Ltd.
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The blood sample images consist of Red Blood Cells, Platelets, White Blood Cells, and Plasma. White Blood Cells are classified into different types and their sub type based on its features. The white blood cells are further classi...
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The blood sample images consist of Red Blood Cells, Platelets, White Blood Cells, and Plasma. White Blood Cells are classified into different types and their sub type based on its features. The white blood cells are further classified as granulocytes, Monocytes and lymphocytes. Leukaemia is a type of blood cancer which causes severe damage to human body if it is left untreated. The counting and classification of blood cells allows in evaluating and diagnosing of vast number of diseases. These diseases can be detected and treated at early stage Analysing of white blood cells (WBCs) allows for detecting acute lymphoblastic leukaemia (ALL). The morphological analysis of blood cells is performed manually by skilled operators. However, this method has many drawbacks such as slow analysis, non-standard accuracy, and dependencies depend on the skills of the operator. This paper presents an automated method for identifying WBC and classifies those using microscopic images. The other approaches identify the leucocytes first and then the other components but the proposed system isolate the whole leucocytes and then separates the cytoplasm and nucleus. This approach is necessary to analyse each cell component and extract its features. From each cell component, various features like shape, colour and texture, are extracted using a new approach for background pixel removal. The feature set obtained was used to train different classification models to determine which one is most suitable for the detection of acute and chronic leukaemia.
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Summary Osteonecrosis (ON) is a well‐known sequela of paediatric acute lymphoblastic leukaemia (ALL) treatment. Incidence differs substantially among studies and the clinical significance of radiological findings is not fully est...
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Summary Osteonecrosis (ON) is a well‐known sequela of paediatric acute lymphoblastic leukaemia (ALL) treatment. Incidence differs substantially among studies and the clinical significance of radiological findings is not fully established. We analysed 256 consecutive patients with ALL treated in our Institution between October 2010 and December 2016. Within the cohort, 41 developed ON, with a mean 5‐year cumulative incidence of 18.5?(standard error, SE, 5.7)% overall. The mean (SE) 5‐year cumulative incidence of ON was 12.7?(2.1)% after censoring upon stem cell transplantation (SCT) and/or relapse. Patients aged ≥10?years and patients allocated to the high‐risk stratum had a 10‐fold and fivefold higher risk of ON respectively. The risk of ON was more than double in relapsed patients, whereas no significant impact of gender, immunophenotype and SCT was demonstrated. Multiple lesions (median four joints involved per patient) were detected by magnetic resonance imaging in all but one patient, with the knee being the most affected joint. Lesions affecting convex joint surfaces experienced the worst evolution, whereas most lesions on diaphyses and concave surfaces remained radiologically stable or disappeared during follow‐up. ON has a high prevalence in paediatric ALL, presenting with multiple lesions. Lesions involving convex surfaces were at higher risk of radiological deterioration.
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Leukaemia is a type of blood cancer which mainly occurs when bone marrow produces excess white blood cells in our body. This disease not only affects adult but also is a common cancer type among children. Treatment of leukaemia de...
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Leukaemia is a type of blood cancer which mainly occurs when bone marrow produces excess white blood cells in our body. This disease not only affects adult but also is a common cancer type among children. Treatment of leukaemia depends on its type and how far the disease has spread in the body. Leukaemia is classified into two types depending on how rapidly it grows: acute and chronic leukaemia. The early diagnosis of this disease is vital for effective treatment and recovery. This paper presents an automated diagnostic system to detect acute lymphoblastic leukaemia (ALL) using a convolutional neural network (CNN) model. The model uses labeled microscopic blood smear images to detect the malignant leukaemia cells. The current work uses data obtained from the Acute Lymphoblastic Leukaemia Image DataBase (ALL_IDB) and performs various data augmentation techniques to increase the number of training data which in effect reduces the over-training problem. The model has been trained on 515 images using a fivefold validation technique achieving an accuracy of 95.54% and further tested on the remaining 221 images achieving almost 100% accuracy during most of the trials, maintaining an average of 99.5% accuracy. The method does not need any pre-processing or segmentation technique and works efficiently on raw data. This method can, hence, prove profitable for pathologist in diagnosing ALL efficiently.
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Severe hyperlipidaemia with asparaginase therapy is rare. We report six cases, four of which developed significant problems with severe hyperlipidaemia during induction therapy for ALL and lymphoblastic lymphoma. The median trigly...
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Severe hyperlipidaemia with asparaginase therapy is rare. We report six cases, four of which developed significant problems with severe hyperlipidaemia during induction therapy for ALL and lymphoblastic lymphoma. The median triglyceride level was 22.3 mmol/L and the median cholesterol level was 12.3 mmol/L. None of the patients showed signs or symptoms of pancreatitis. Three children were re-exposed with Peg asparaginase, and one with Erwinia asparaginase, without recurrence of hyperlipidaemia or other symptoms. These cases highlight the dilemma in managing such rare cases of symptomatic hypertriglyceridaemia secondary to asparaginase and steroid therapy.
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Acute lymphoblastic leukaemia (ALL) of the B-cell lineage (B-ALL) is a malignant neoplasm identified by the accumulation of immature lymphoid progenitor cells in bone marrow and blood. Numerous chromosomal aberrations have been fo...
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Acute lymphoblastic leukaemia (ALL) of the B-cell lineage (B-ALL) is a malignant neoplasm identified by the accumulation of immature lymphoid progenitor cells in bone marrow and blood. Numerous chromosomal aberrations have been found to be correlated with disease, relapse and its clinical outcome. The survival and cure rate has been improved drastically with the advent of modern methods of diagnosis and availability of targeted pharmacological agents. However, the limitation is the higher incidence of relapsed disease. An 8-year old male child was diagnosed with B-ALL, the disease relapsed despite proper therapeutic regimen after reporting to the hospital. Conventional cytogenetic analysis revealed a normal male karyotype. FISH panel for B-ALL including t(9;22) BCR-ABL, t(12;21) ETV6-RUNX1, KMT2A (11q23) rearrangement and t(1;19) PBX1-E2A was performed and was positive for translocation t(12;21) ETV6-RUNX1 in 70% of the cells at the time of diagnosis. At the time of relapse, patient underwent cytogenetics workup including cytogenetics and FISH. Bone Marrow karyotyping showed a male karyotype with t(12;21) in all the metaphases studied and FISH was positive for translocation t(12;21) ETV6-RUNX1 in 90% of the cells. Also, next-generation sequencing for 57 gene panel showed a novel single nucleotide polymorphism (SNP) in the FLT3 gene in exon 24, c.2888C>T. Taken together, these genetic abnormalities may have an important contribution to a good prognosis and therapeutic efficacy post relapse in the present case study. The clinical functionality of novel SNP reported in the FLT3 gene should be further explored in relation to diagnosis and clinical outcome of a disease.
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Abstract Leukaemia is the principal cancer of childhood. In the last few decades, cure rates in childhood leukaemia have improved due to better risk stratification of patients by phenotype/genotype and treatment-related response, ...
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Abstract Leukaemia is the principal cancer of childhood. In the last few decades, cure rates in childhood leukaemia have improved due to better risk stratification of patients by phenotype/genotype and treatment-related response, incorporation of more effective chemotherapy protocols and better supportive care. Current research in acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) aims to reduce treatment related toxicity by studying innovative ways to deliver therapy without compromising treatment efficacy and thereby improving outcomes for children. This review discusses how acute leukaemia occurs and presents and describes current treatment strategies in ALL and AML.
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Considering the heterogeneity of leukaemias and the widening spectrum of therapeutic strategies, novel diagnosticmethods are urgently needed for haematological malignancies. For a decade, gene expression profiling (GEP) hasbeen ap...
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Considering the heterogeneity of leukaemias and the widening spectrum of therapeutic strategies, novel diagnosticmethods are urgently needed for haematological malignancies. For a decade, gene expression profiling (GEP) hasbeen applied in leukaemia research. Thus, various studies demonstrated worldwide that the majority of geneticallydefined leukaemia subtypes are accurately predictable by GEP, for example, with respect to reciprocal rearrange-ments in acute myeloid leukaemia (AML). Moreover, novel prognostically relevant gene classifiers were developedas, for example, in normal karyotype AML. Considering the lymphatic malignancies, GEP studies defined novelclinically relevant subtypes in diffuse large B cell lymphoma (DLBCL), and improved the discrimination of Burkittlymphoma and DLBCL cases, overcoming considerable overlaps of these entities that exist from morphologicaland genetic perspectives. Treatment-specific sensitivity assays are being developed for targeted drugs such as farne-syl transferase inhibitors in AML or imatinib in BCR-ABLI positive acute lymphoblastic leukaemia (ALL).Irrespectively of these proceedings, an introduction of the microarray technology in haematological practicerequires diagnostic algorithms and strategies for interaction with currently established diagnostic techniques.Large multicentre studies such as the MILE Study (Microarray Innovations in LEukemia) aim at translating this meth-odology into clinical routine workflows and to catalyze this process.
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